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Jason A. Smith, DO
Associated Cardiovascular Consultants at
Lourdes Cardiology Services
Disclosures
No disclosures
Hypertension
Systolic Diastolic
Category
(mmHg) (mmHg)
Normal < 120 and < 80
Hypertension
Hypertension:
SBP >140 mmHg ± DBP >90 mmHg
* The blood pressure (BP) category is defined by the highest level of BP, whether systolic or diastolic. Isolated systolic
hypertension should be graded 1, 2, or 3 according to systolic BP values in the ranges indicated.
The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) - J Hypertension 2013;31:1281-1357
Medical Education & Information – for all Media, all Disciplines, from all over the World
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JNC 8
A – Strong evidence
B – Moderate evidence
C – Weak evidence
D – Against
E – Expert Opinion
N – No recommendation
JNC 8: Drug Treatment
Thresholds and Goals
• Age > 60 yo
– Systolic:
• Threshold > 150 mmHg
• Goal < 150 mmHg
– LOE: Grade A
– Diastolic:
• Threshold > 90 mmHg
• Goal < 90 mmHg
– LOE: Grade A
JNC 8: Drug Treatment
Thresholds and Goals
• Age < 60 yo
– Systolic:
• Threshold > 140 mmHg
• Goal < 140 mmHg
– LOE: Grade E
– Diastolic:
• Threshold > 90 mmHg
• Goal < 90 mmHg
– LOE: Grade A for ages 40-59; Grade E for ages 18-
39
JNC 8: Drug Treatment
Thresholds and Goals
• Age > 18 yo with CKD or DM
– JNC 7: < 130/80 (MDRD NEJM 1994)
– Systolic:
• Threshold > 140 mmHg
• Goal < 140 mmHg
– LOE: Grade E
– Diastolic:
• Threshold > 90 mmHg
• Goal < 90 mmHg
– LOE: Grade E
JNC 8: Initial Drug Choice
• Nonblack, including DM
– Thiazide diuretic, CCB, ACEI, ARB
• LOE: Grade B
• Black, including DM
– Thiazide diuretic, CCB
• LOE: Grade B (Grade C for diabetics)
JNC 8: Initial Drug Choice
SBP goal for elderly >80 years with SBP 140-150 mmHg
•≥160 mmHg
SBP, systolic blood pressure; CV, cardiovascular; TIA, transient ischaemic attack; CHD, coronary heart disease; CKD, chronic kidney disease;
DBP, diastolic blood pressure.
The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) - J Hypertension 2013;31:1281-1357
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BP goal in the elderly
2013 ESH/ESC Guidelines for the management of arterial hypertension
SBP, systolic blood pressure; DBP, diastolic blood pressure; RAS, renin–angiotensin system.
The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) - J Hypertension 2013;31:1281-1357
Medical Education & Information – for all Media, all Disciplines, from all over the World
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2013 ESH/ESC Guidelines for the management of arterial hypertension
Consider SBP <130 mmHg with overt proteinuria • Monitor changes in eGFR
Combination therapy usually required to reach BP • Combine RAS blockers with other agents
goals
Aldosterone antagonist not recommended in CKD • Especially in combination with a RAS blocker
• Risk of excessive reduction in renal function,
hyperkalemia
SBP, systolic blood pressure; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; RAS, renin–angiotensin system.
The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) - J Hypertension 2013;31:1281-1357
Medical Education & Information – for all Media, all Disciplines, from all over the World
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What is the goal BP?
Comparison of Recent
Guideline Statements
B-blocker No Yes No No
First line Rx
Quit smoking
The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) - J Hypertension 2013;31:1281-1357
Medical Education & Information – for all Media, all Disciplines, from all over the World
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Thank you for your attention!
smithj@lourdesnet.org